Practice Management Q&As

When a patient rejects your advice

While reviewing a new patient's hospital records, I noticed that a radiologist had reported an abnormality six months earlier and had recommended a follow-up X-ray. When I discussed this with the patient, he said he wasn't aware of the finding and rejected my advice to get the X-ray immediately. He claimed he couldn't afford it until his wife's health insurance kicked in at her new job. I documented his remarks in his chart, but I'm wondering if there's anything else I should do. Should I dismiss him for noncompliance?

No, it's not necessary to dismiss him. However, in addition to documenting your advice in the patient's chart, you should send him a letter by certified mail, return-receipt requested. Repeat your advice to get the follow-up X-ray and spell out the potential consequences of delay. File a copy in the patient's chart along with the proof of receipt. This letter will help bolster your defense if, in the future, he claims you were negligent in this matter.

Several patients with large outstanding accounts have resisted all attempts to get them to pay. They even ignore the collection agency. Should I take them to small-claims court?

It's not likely to work. Even if you win at the small claims level, getting any money you're awarded can be very time-consuming and complicated, and there's no assurance you'll ever get paid.

At this point, the best approach is to have your attorney send these patients a letter demanding payment. He's no doubt experienced in such matters and will know the most effective way to prompt them to pay. However, it may be that some accounts are just uncollectible.

Unbillable services-are they tax-deductible?

Is there any way we can write off unbillable services-such as telephone calls and processing prescription refills-as tax deductions?

No. Services that aren't billable aren't deductible. You can deduct the actual costs you incur-your telephone bills and staff salary, for example-but you can't write off the value of your staff's time as a business expense.

Accommodating disabled patients

The second-floor office where I'd like to set up my internal medicine practice is not accessible to patients in wheelchairs. However, if I need to see any wheelchair-bound patients, another physician in the building has offered to let me use his office downstairs. Would this arrangement satisfy ADA regulations? Also, what changes will I have to make to the restrooms to accommodate handicapped patients?

Such an arrangement probably would not comply with ADA regulations-unless you have unlimited use of your colleague's office during your regularly scheduled hours. It would be discriminatory to restrict your wheelchair-bound patients' visits to certain days or times when the downstairs office was available to you.

Restrooms should be both accessible and usable. For example, this may require widening a doorway so a wheelchair could pass through, lowering a sink, or fixing a grab bar to the wall next to a toilet. However, under the ADA, you're required to make only "readily achievable" modifications. That means the modifications can be easily accomplished without much difficulty or excessive expense that could harm your business. For more information, see the ADA Guide for Small Businesses, available at ada.gov/smbusgd.pdf. Be sure to ask your attorney how these rules apply to your specific situation.